Patient blood management nurse vs transfusion nurse: is it time to merge?

For many years, nurses have performed the tasks related to blood transfusion monitoring and the associated quality-control documentation. There have been multiple job titles given to healthcare providers in this field: haemovigilance officer, transfusion practitioner, transfusion nurse, patient blood management (PBM) nurse, blood conservation nurse and blood management nurse. These titles share some overlap in tasks. In this article, the authors discuss Australian and US experiences of the historical transfusion nurse role, and the newer title of PBM nurse. The article will attempt to answer the question: is it time these two job titles and roles were merged into one, creating the evolved role of PBM nurse? It will define the unique nature of these roles and attempt to explore any differences between them. PBM is becoming a standard of care and embedded in institutions around the world. The transition and adoption of a joint role is timely, and the article also addresses the issue of appropriate staffing levels. PBM has become the overarching phrase that addresses the prevention of transfusion as well as the quality and safety needs of transfusion medicine. The authors propose it is time to merge the roles of the PBM nurse and the transfusion nurse, which would ultimately benefit patients, as well as more thoroughly address the needs of hospitals.

A pragmatic approach to embedding patient blood management in a tertiary hospital.

BACKGROUND: We describe the implementation and impact of a patient blood management program (PBMP) in an Australian teaching hospital. STUDY DESIGN AND METHODS: A PBMP was introduced at a single tertiary care hospital in 2009 as a pilot for the Western Australian Health Department statewide PBMP. The first 3 years of interventions aimed to make effective use of preoperative clinics, manage perioperative anemia, improve perioperative hemostasis, reduce blood sample volumes, and implement restrictive transfusion triggers and a single-unit transfusion policy. RESULTS: Between 2008 and 2011, admissions to Fremantle Hospital and Health Services increased by 22%. Using 2008 as a reference year, the mean number of red blood cell (RBC) units per admission declined 26% by 2011. Use of fresh-frozen plasma and platelets showed 38 and 16% declines, respectively. Cryoprecipitate increased 7% over the 4-year period. For elective admissions between 2008 and 2011, the leading decline in RBC transfusion rate was seen in cardiothoracic surgery (27.5% to 12.8%). The proportion of single RBC unit use increased from 13% to 28% (p < 0.001), and the proportion of double units decreased from 48% to 37% (p < 0.001). CONCLUSION: This is the first tertiary hospital in Australia to establish a multidisciplinary multimodal PBMP. Interventions across disciplines resulted in decreased use of RBC units especially in orthopedic and cardiothoracic surgery. Continuing education and feedback to specialties will maintain the program, improve patient outcomes, and decrease the transfusion rate.